Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Flu vaccine - screenshots - B	Form	New	Available
Flu vaccine - screenshots - A	Form	New	Available
Flu shots - screenshots - B	Form	New	Available
Flu shots - screenshots - A	Form	New	Available
Congenital Heart Defects - screenshots - B	Form	New	Available
Congenital Heart Defects - screenshots - A	Form	New	Available
Emergency Supplies - screenshots - B	Form	New	Available
Emergency Supplies - screenshots - A	Form	New	Available
Integrated Pest Management - screenshots - B	Form	New	Available
Integrated Pest Management - screenshots - A	Form	New	Available
Environmental Health - Screenshots - B	Form	New	Available
Environmental Health Training - screenshots - A	Form	New	Available
Mental Health among Women - screenshots - B	Form	New	Available
Mental Health among Women screenshots - A	Form	New	Available
Survey	Form	New	Available
CDC Digital Health Tools Survey - word	Form	New	Available
CDC Digital Health Tools Survey	Form	New	Available
English Homepage Survey	Form	New	Available
Spanish Homepage Survey	Form	New	Available
Card Sort Screenshots	Form	New	Available
CDC Homepage Survey	Form	New	Available
Survey	Form	Modified	Available
Questionnaire	Form	Modified	Available
Participant Scenario List	Form	Modified	Available
Attachment 2: Click Testing Screen Shots	Form and Instruction	Modified	Available
Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri	Form and Instruction	Modified	Available
Attachment 9: CDC Priorities and FY 2014 Budget Request	Form and Instruction	Modified	Available
Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention	Form and Instruction	Modified	Available
Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe	Form and Instruction	Modified	Available
Attachment 6: Heart Disease Facts	Form and Instruction	Modified	Available
Attachment 5: HAI Summary Data Reports: Questions and Answers	Form and Instruction	Modified	Available
Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know	Form and Instruction	Modified	Available
Attachment 3: Flu Vaccine Information for Health Care Workers	Form and Instruction	Modified	Available
CDC Homepage Mobile & Desktop Survey	Form	Modified	Available
CDC Homepage Mobile and Desktop	Form	Modified	Available
Survey	Form	Modified	Available
Vital Signs Survey	Form and Instruction	Modified	Available
Vital Signs Survey	Form and Instruction	Modified	Available
change for 0920-0956.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-02-20	Available
Att.B_9-Before-Policymakers-Budget.pdf	Supplementary Document	Uploaded 2014-02-20	Available
Att.B_2-After-Clinicians-Flu.pdf	Supplementary Document	Uploaded 2014-02-20	Available
GenIC_Index Web Survey.corrected.docx	Supplementary Document	Uploaded 2014-02-12	Available
Att.L Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_16-After-Health-Departments-NVDRS.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_15-Before-HealthDept-NVDRS_2013.12.12.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_14 -After-Health-Departments-MAHC.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_13-Before-Health-Departments-MAHC.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_12- After-Policymakers-Epidemiology.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_11-Before-Policymakers-Epidemiology.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_10-After-Policymakers-Budget.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_8-After-Partners-Heart-Disease.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_7- Before-Partners-Heart-Disease.png	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_6-After-Partners-HAI.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_5- Before-Partners-HAI.png	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_4- After-Clinicians-Wisconsin.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_3-Before-Clinicians-Wisconsin.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.B_1-Before-Clinicians-Flu.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Att.A-Web Survey Protocol.docx	Supplementary Document	Uploaded 2014-02-12	Available
E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB.docx	Supplementary Document	Uploaded 2014-01-10	Available
C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB.docx	Supplementary Document	Uploaded 2014-01-10	Available
B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB.docx	Supplementary Document	Uploaded 2014-01-10	Available
A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB.docx	Supplementary Document	Uploaded 2014-01-10	Available
fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014.docx	Supplementary Document	Uploaded 2014-01-10	Available
D-Scenarios -CDChomepageUX121613 - OMB.docx	Supplementary Document	Uploaded 2013-12-16	Available
C-Consent Forms -CDChomepageUX121013 - OMB.docx	Supplementary Document	Uploaded 2013-12-16	Available
B - Instructions -CDChomepageUX121613 - OMB.docx	Supplementary Document	Uploaded 2013-12-16	Available
A-PROTOCOL-CDChomepageUX121013.docx	Supplementary Document	Uploaded 2013-12-16	Available
fast-track-PRA-submission-short-form-cdc-CDChomepageUX121613.docx	Supplementary Document	Uploaded 2013-12-16	Available
Attachment1_CDC-Index-Click-testing-Protocol_2013.11.07.docx	Supplementary Document	Uploaded 2013-11-20	Available
List of Attachments for Testing of Sample Materials Developed Using the CDC Clear Communications Index.docx	Supplementary Document	Uploaded 2013-11-20	Available
GenIC_Index Click Test 2013.11.06.docx	Supplementary Document	Uploaded 2013-11-20	Available
fast-track-PRA-submission-short-form-cdc homepage mobile desktop.doc	Supplementary Document	Uploaded 2013-09-04	Available
Solve the Outbreak User Zoom Questions.docx	Supplementary Document	Uploaded 2013-06-26	Available
Surveytemplate _SolvetheOutbreak.docx	Supplementary Document	Uploaded 2013-06-26	Available
Survey1template _VitalSignsv2.docx	Supplementary Document	Uploaded 2013-06-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214226	Testing GovDelivery	Form	New	Flu vaccine - screenshots - B
214226	Testing GovDelivery	Form	New	Flu vaccine - screenshots - A
214226	Testing GovDelivery	Form	New	Flu shots - screenshots - B
214226	Testing GovDelivery	Form	New	Flu shots - screenshots - A
214226	Testing GovDelivery	Form	New	Congenital Heart Defects - screenshots - B
214226	Testing GovDelivery	Form	New	Congenital Heart Defects - screenshots - A
214226	Testing GovDelivery	Form	New	Emergency Supplies - screenshots - B
214226	Testing GovDelivery	Form	New	Emergency Supplies - screenshots - A
214226	Testing GovDelivery	Form	New	Integrated Pest Management - screenshots - B
214226	Testing GovDelivery	Form	New	Integrated Pest Management - screenshots - A
214226	Testing GovDelivery	Form	New	Environmental Health - Screenshots - B
214226	Testing GovDelivery	Form	New	Environmental Health Training - screenshots - A
214226	Testing GovDelivery	Form	New	Mental Health among Women - screenshots - B
214226	Testing GovDelivery	Form	New	Mental Health among Women screenshots - A
214226	Testing GovDelivery	Form	New	Survey
213571	CDC Digital Health Tools Evaluation	Form	New	CDC Digital Health Tools Survey - word
213571	CDC Digital Health Tools Evaluation	Form	New	CDC Digital Health Tools Survey
212305	Solve the Outbreak Mobile App Survey	Other-WORD	New
212251	CDC Spanish Homepage Survey	Form	New	English Homepage Survey
212251	CDC Spanish Homepage Survey	Form	New	Spanish Homepage Survey
212040	CDC Social Media Satisfaction Survey	Other-WORD	New
211673	CDC Flu Site - Card Sort	Form	New	Card Sort Screenshots
211632	CDC Homepage UX -- After Release	Other-WORD	New
211032	CDC Homepage Post-launch Survey	Form	New	CDC Homepage Survey
210376	Testing Clear Communication Index Website	Form	Modified	Survey
210038	Solve the Outbreak (14GM)	Form	Modified	Questionnaire
210038	Solve the Outbreak (14GM)	Other-Screenshots	Modified
209701	CDC Homepage UX	Form	Modified	Participant Scenario List
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 2: Click Testing Screen Shots
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 9: CDC Priorities and FY 2014 Budget Request
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 6: Heart Disease Facts
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 5: HAI Summary Data Reports: Questions and Answers
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know
209487	Testing of Sample Materials Developed Using the CDC Clear Communications Index	Form and Instruction	Modified	Attachment 3: Flu Vaccine Information for Health Care Workers
208545	CDC Homepage Mobile & Desktop Survey	Form	Modified	CDC Homepage Mobile & Desktop Survey
208545	CDC Homepage Mobile & Desktop Survey	Form	Modified	CDC Homepage Mobile and Desktop
207575	Solve the Outbreak iPad Survey	Form	Modified	Survey
207398	Vital Signs Survey	Form and Instruction	Modified	Vital Signs Survey
207398	Vital Signs Survey	Form and Instruction	Modified	Vital Signs Survey

ICR Details

OMB Control No: 0920-0956	ICR Reference No: 201402-0920-015
Status: Historical Active	Previous ICR Reference No: 201303-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 21469
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/27/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2014
Terms of Clearance: Previous terms continue: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.¿

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	03/31/2016	03/31/2016
Responses	30,750	0	10,250
Time Burden (Hours)	15,750	0	5,250
Cost Burden (Dollars)	0	0	0

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Abstract: This request for nonsubstantive change is to correct an error made by CDC when the generic ICR was submitted. The number of responses and burden hours were entered for one year of information collection, and should have been tripled to account for the 3 years of clearance.

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Authorizing Statute(s): US Code: 42 USC 41 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
CDC Digital Health Tools Evaluation	none, none	CDC Digital Health Tools Survey ,   CDC Digital Health Tools Survey - word
CDC Flu Site - Card Sort	none	Card Sort Screenshots
CDC Homepage Mobile & Desktop Survey	None, None	CDC Homepage Mobile and Desktop ,   CDC Homepage Mobile & Desktop Survey
CDC Homepage Post-launch Survey	none	CDC Homepage Survey
CDC Homepage UX	none	Participant Scenario List
CDC Homepage UX -- After Release
CDC Social Media Satisfaction Survey
CDC Spanish Homepage Survey	none, none	Spanish Homepage Survey ,   English Homepage Survey
Solve the Outbreak (14GM)	none	Questionnaire
Solve the Outbreak Mobile App Survey
Solve the Outbreak iPad Survey	none	Survey
Testing Clear Communication Index Website	none	Survey
Testing GovDelivery	none, none, none, none, none, none, none, none, none, none, none, none, none, none, none	Survey ,   Mental Health among Women screenshots - A ,   Mental Health among Women - screenshots - B ,   Environmental Health Training - screenshots - A ,   Environmental Health - Screenshots - B ,   Integrated Pest Management - screenshots - A ,   Integrated Pest Management - screenshots - B ,   Emergency Supplies - screenshots - A ,   Emergency Supplies - screenshots - B ,   Congenital Heart Defects - screenshots - A ,   Congenital Heart Defects - screenshots - B ,   Flu shots - screenshots - A ,   Flu shots - screenshots - B ,   Flu vaccine - screenshots - A ,   Flu vaccine - screenshots - B
Testing of Sample Materials Developed Using the CDC Clear Communications Index	None, None, None, None, None, None, None, None, None	Attachment 3: Flu Vaccine Information for Health Care Workers ,   Attachment 4: Autism and Developmental Disabilities Monitoring Network (ADDM) Tracking Autism in Wisconsin: What You Need to Know ,   Attachment 5: HAI Summary Data Reports: Questions and Answers ,   Attachment 6: Heart Disease Facts ,   Attachment 7: Use the Model Aquatic Health Code to Make Swimming Healthy and Safe ,   Attachment 8: The National Violent Death Reporting System (NVDRS): A Valuable Tool for Prevention ,   Attachment 9: CDC Priorities and FY 2014 Budget Request ,   Attachment 10: CDC Keeps America Healthy, Safe, and Secure. Case Study: Fort Leonard Wood, Missouri ,   Attachment 2: Click Testing Screen Shots
Vital Signs Survey	None, None	Vital Signs Survey ,   Vital Signs Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30,750	10,250	0	20,500	0	0
Annual Time Burden (Hours)	15,750	5,250	0	10,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This change request is to add respondents and burden hours due to an error in the original clearance request.

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Annual Cost to Federal Government: $36,130

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/25/2014

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